Receipt-form



J. A. BOUCHER.

RECEIPT FORM.

APPLICATION FILED DEC. I0, |918.

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I I EEnnNaL/fmi N/NTH 11155K Ulf/misa? UNITED sTATss JOSEPH ARTHUR BOUCHER, OT! IVIONTREAL, QUEBEC, CANADA.

RECEIPT-FORM.

Specification of Letters Patent.

Patented July 5, 1921.

replication med December 1o, 191s. serial no. 266,086.

i 1o all whom t may concer/a:

Be it known that I, JOSEPH ARTHUR BOUCHER, a subject or the King of Great Britain, and resident the city o' Montreal, in the Province oit Quebec, Dominion of Canada, havel invented new and useful Improvements in Receipt-Forms, of which the following is a specification.

This invention relates to improvements in contract forms, especially for contracts involving a number of consecutive, serial payments such, for example, as the contracts written by industrial insurance companies,

and the objects of the invention are to faciltate the collection of the payments, to prevent error, to save time in making the collection and to avoid fraud on the part of the collector. Y

Further objects are to insure that no money be collected without an oiiicial receipt being given. Further objects still are to reduce the amount of bookkeeping necessary, to enable the contract formV itself to constitute a complete record of the transaction, giving the exact standing at any particular period, in such a form as to constitute such legal proof as will be indisputable. The invention consists essentially of the improved form hereinafter described in detail in the accompanying specication and drawings.

In the drawings:

Figure 1 is a plan view of the face of the form embodying the invention.

Fig. 2 is a detail in plan of a portion of the back of the form illustrated in Fig. 1.

In the drawings like characters of reference indicate corresponding parts inV all the iigures.

By reference to the drawingsy it will be seen that the form comprises a sheet ruled to provide a series of detachable coupons A, which may be separated from each other by perforations or weakened lines so that they may be readily detached. In addition to the coupons a space B is provided in which Vthe prinicpal terms of the contract may be printed. The coupons correspond in number to the number of serial payments to be made under the contract and will be numbered consecutively. rIhey also bear on their face the amount of the payment and the date that it is to be made; on'the back of each coupon is marked the year of the payment and the number of the coupon in the series, that is to say, whether the payment is for the iirst week, the second week or so on.

rIhe Yform is further provided by ruling, with a plurality ot checking spaces C which are in number the same as the number of coupons, and are numbered to correspond with the serial number of the coupon, this being designed to receive the inspectors initials or checking mark. A. further space D may also be provided to contain particulars as to the collector, checker, cashier, district number, etc.

The form per se does not constitute a contract but is used in the collection of payments, etc., to be made in the fulfilment of a contract. Each form is identified by having printed or otherwise shown thereon some of the terms of the contract, and in the embodiment illustrated it will show the contracting parties, the nature of the contract, the payments to be made and when due, the checkingsystem, etc.

It will be understood that the contract proper, which has nothing to do with the present invention may have certain other terms which would not be disclosed in the form which constitutes the present invention, because such terms would not have any bearing on the collection of the dues or the L.

checking, etc., of such dues.

way of illustration the form has been shown as for a policy in Boucherys Industrial Insurance Co., Ltd, twenty year endowments, one hundred dollar policy having a weekly premium of ten cents, the policy being issued Dec. 12, 1901, and being due Dec. 12, 1921; these particulars with the number of the policy being printed in the space B. The sheet is shown as having twenty-six coupons which will serve for one-half years payments, each coupon being marked on the back with the year and as to the number of the week or payment in the series, thereby the period covered by the contract is indicated in the space D, that is to say, the weekly payments to cover from .I an. 6 to J une 30, inclusive, the exact date of the payment being indicated on the coupon itself.

In using the form for the purpose illustrated the treasurer of the insurance company will issue each year a number of receipts to be collected at different dates during the year. They may be weekly or monthly payments. These sheets will be distributed to diiferent sections and charged to to the same. These sections Will then deliver the forms to the district agents Who pass lthem to the local collectors, the treasurer thus issuing millions ot forms all different. The collector when being paid an instal- Y ment ot the dues Will detach a particular Vcoupon forming a receipt 'for that particular payment, and he Will exchange this coupon at the insureds house tor the fee, which' will be returned to the head otlice by the same channel in issued. i

An un aid oremium will leave the cou-` Y P l pon attached to its form which Will be returned in due course to thehead otlfce. When a coupon is detached from the contract term then it signifies that the payment corre spending to such coupon has been made, and

this-isa sufiicient valid receipt, althoughv at the same time the coupon in the hands ot the insured person Would also form a receipt, so that there is a double checking 'ot the moneys paid in connection with any particular.

policy.

VShould placed by a special receipt, which would have all the characteristics of the ordinary coupon and would only differ theretronn'by the collector indicating the reason Why he issued the special receipt. lf any errors occur in Vdistributing receipts, it would be very easy to trace them, as the right receipt will be Vat its place on the sheet if another has been delivered by accident.Y It will be observed that in this manner 01"' mal-:ingr Ycol-Q lection considerable time and work willV be saved as no Writing will be done by the collector; the collector having received the premium will preferably enter the same in a suitable Bordereau with attached receipt coupon to be returnedV to the collector. .A numbered receipt book Will also beprelierably kept by the insured, made ol `gum paper, having numbered spaces corresponding to the serial numbers on the coupons upon lWhichthe coupons maybe stuck and which Y will thus indicate to him that the payments have been made regularly without omission.

It will be seen that this system avoids the error ot entries made by Vthe collectors or in theinsui'eds receipt book.` t is also impossible tor the collector to collect advance Jfees Without therinspector or checker noting .it Yby the absence ot receipts on the sheet.

The collectors make their returns to the disivhicli the r'ceipt tormsvare any receipt be lost it may be re-..

vinprinted therein.

As many changes could be made 1in the above construction and manyV apparentlyV widely different embodiments ot' my invention Within-*theV scope of the claim, constructed Without departing-trom the spirit or scope thereof,- itis intended that all `l`mattei' contained in 'the accompanying sge'cii'icationVV and drawings shallpbe interpret-cdas illustrative and not' in ajlimiting sense.

lVhat I claim as my inventionis:

A contract form designedto cover a contract and calling for a Ynumber `ort serial paymentsY comprising a sheet ruled. with horizontal and vertical linesto prot/ide a series ot coupons on its face, the said coupons er;- tending to VoneV side and one bottomot the tace, and having `printed on theiback there- `ot the numerical orderV or' the serial payment, eachv coupon further having y printed on the tace thereot the amount Vot the payment and the serial number yor thecontract;

.a space Y above 4Vthe couponv in which the terms and serial number of ajcontra'ctlare lar checking lspaces @immediately 'to one sideoil the coupons, .each of the Vnumbers on the checking spaces corresponding with one `number ot the numerated payments printed printed, and a'seiies ot numbered rectanguon the baclroif the coupons, eachV form further havingraspae E bounded bythe rectangular Y checking spaces, thecoupons and the space and having printed thereon particulars as to the serial Ynumber ot the 'contr-act, division oit the territory for the distribution of the forms,cashier, collector, checkeiyaiid space D above the rectangular checkingYV space Gandadjacentto the space B, hav-V ing particulars as tothe .number ot receipts andthe number ot the slieetrot' the contract In witness ivhereo'f'l have hereunto set my hand.

Josnrri nari-inn BOUCHER, A 

